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art.019/6/019/5/019/4/019/3/019/2/019/1

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ARTICLE 19 AS AMENDED

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RELATING TO MEDICAL ASSISTANCE

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     SECTION 1. Sections 40-8-13.4, 40-8-17 and 40-8-19 of the General Laws in Chapter

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40-8 entitled "Medical Assistance" are hereby amended to read as follows:

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     40-8-13.4. Rate methodology for payment for in state and out of state hospital

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services.-- (a) The department executive office of health and human services shall implement a

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new methodology for payment for in state and out of state hospital services in order to ensure

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access to and the provision of high quality and cost-effective hospital care to its eligible

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recipients.

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     (b) In order to improve efficiency and cost effectiveness, the department executive office

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of health and human services shall:

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     (1) (A) With respect to inpatient services for persons in fee for service Medicaid, which is

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non-managed care, implement a new payment methodology for inpatient services utilizing the

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Diagnosis Related Groups (DRG) method of payment, which is, a patient classification method

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which provides a means of relating payment to the hospitals to the type of patients cared for by

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the hospitals. It is understood that a payment method based on Diagnosis Related Groups may

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include cost outlier payments and other specific exceptions. The department executive office will

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review the DRG payment method and the DRG base price annually, making adjustments as

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appropriate in consideration of such elements as trends in hospital input costs, patterns in hospital

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coding, beneficiary access to care, and the Center for Medicare and Medicaid Services national

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CMS Prospective Payment System (IPPS) Hospital Input Price index. 

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     (B) With respect to inpatient services, (i) it is required as of January 1, 2011 until

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December 31, 2011, that the Medicaid managed care payment rates between each hospital and

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health plan shall not exceed ninety and one tenth percent (90.1%) of the rate in effect as of June

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30, 2010. Negotiated increases in inpatient hospital payments for each annual twelve (12) month

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period beginning January 1, 2012 may not exceed the Centers for Medicare and Medicaid

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Services national CMS Prospective Payment System (IPPS) Hospital Input Price index for the

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applicable period; (ii) provided, however, for the twelve (12) month period beginning July 1,

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2013 the Medicaid managed care payment rates between each hospital and health plan shall not

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exceed the payment rates in effect as of January 1, 2013; (iii) negotiated increases in inpatient

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hospital payments for each annual twelve (12) month period beginning July 1, 2014 may not

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exceed the Centers for Medicare and Medicaid Services national CMS Prospective Payment

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System (IPPS) Hospital Input Price Index, less Productivity Adjustment, for the applicable

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period; (iv) The Rhode Island department executive office of health and human services will

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develop an audit methodology and process to assure that savings associated with the payment

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reductions will accrue directly to the Rhode Island Medicaid program through reduced managed

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care plan payments and shall not be retained by the managed care plans; (iii) (v) All hospitals

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licensed in Rhode Island shall accept such payment rates as payment in full; and (iv) (vi) for all

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such hospitals, compliance with the provisions of this section shall be a condition of participation

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in the Rhode Island Medicaid program. 

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     (2) With respect to outpatient services and notwithstanding any provisions of the law to

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the contrary, for persons enrolled in fee for service Medicaid, the department executive office will

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reimburse hospitals for outpatient services using a rate methodology determined by the

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department executive office and in accordance with federal regulations. Fee-for-service outpatient

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rates shall align with Medicare payments for similar services. Changes Notwithstanding the

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above, there shall be no increase in the Medicaid fee-for-service outpatient rates effective July 1,

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2013. Thereafter, changes to outpatient rates will be implemented on July 1 each year and shall

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align with Medicare payments for similar services from the prior federal fiscal year. With respect

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to the outpatient rate, (i) it is required as of January 1, 2011 until December 31, 2011, that the

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Medicaid managed care payment rates between each hospital and health plan shall not exceed one

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hundred percent (100%) of the rate in effect as of June 30, 2010. Negotiated increases in hospital

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outpatient payments for each annual twelve (12) month period beginning January 1, 2012 may

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not exceed the Centers for Medicare and Medicaid Services national CMS Outpatient Prospective

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Payment System (OPPS) hospital price index for the applicable period.; (ii) provided, however,

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for the twelve (12) month period beginning July 1, 2013 the Medicaid managed care outpatient

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payment rates between each hospital and health plan shall not exceed the payment rates in effect

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as of January 1, 2013; (iii) negotiated increases in outpatient hospital payments for each annual

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twelve (12) month period beginning July 1, 2014 may not exceed the Centers for Medicare and

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Medicaid Services national CMS Outpatient Prospective Payment System (OPPS) Hospital Input

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Price Index, less Productivity Adjustment, for the applicable period.

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     (c) It is intended that payment utilizing the Diagnosis Related Groups method shall

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reward hospitals for providing the most efficient care, and provide the department executive

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office the opportunity to conduct value based purchasing of inpatient care. 

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     (d) The director secretary of the department executive office of health and human

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services and/or the secretary of executive office of health and human services is hereby

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authorized to promulgate such rules and regulations consistent with this chapter, and to establish

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fiscal procedures he or she deems necessary for the proper implementation and administration of

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this chapter in order to provide payment to hospitals using the Diagnosis Related Group payment

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methodology. Furthermore, amendment of the Rhode Island state plan for medical assistance

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(Medicaid) pursuant to Title XIX of the federal Social Security Act is hereby authorized to

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provide for payment to hospitals for services provided to eligible recipients in accordance with

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this chapter. 

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     (e) The department executive office shall comply with all public notice requirements

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necessary to implement these rate changes. 

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     (f) As a condition of participation in the DRG methodology for payment of hospital

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services, every hospital shall submit year-end settlement reports to the department executive

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office within one year from the close of a hospital’s fiscal year. Should a participating hospital

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fail to timely submit a year-end settlement report as required by this section, the department

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executive office shall withhold financial cycle payments due by any state agency with respect to

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this hospital by not more than ten percent (10%) until said report is submitted. For hospital fiscal

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year 2010 and all subsequent fiscal years, hospitals will not be required to submit year-end

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settlement reports on payments for outpatient services. For hospital fiscal year 2011 and all

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subsequent fiscal years, hospitals will not be required to submit year-end settlement reports on

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claims for hospital inpatient services. Further, for hospital fiscal year 2010, hospital inpatient

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claims subject to settlement shall include only those claims received between October 1, 2009

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and June 30, 2010.

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     (g) The provisions of this section shall be effective upon implementation of the

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amendments and new payment methodology pursuant to this section and § 40-8-13.3, which shall

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in any event be no later than March 30, 2010, at which time the provisions of §§ 40-8-13.2, 27-

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19-14, 27-19-15, and 27-19-16 shall be repealed in their entirety. 

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     (h) The director of the Department of Human Services shall establish an independent

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study commission comprised of representatives of the hospital network, representatives from the

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communities the hospitals serve, state and local policy makers and any other stakeholders or

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consumers interested in improving the access and affordability of hospital care.

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     The study commission shall assist the director in identifying: issues of concern and

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priorities in the community hospital system, the delivery of services and rate structures, including

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graduate medical education and training programs; and opportunities for building sustainable and

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effective pubic-private partnerships that support the missions of the department and the state’s

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community hospitals. 

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     The director of the Department of Human Services shall report to the chairpersons of the

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House and Senate Finance Committees the findings and recommendations of the study

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commission by December 31, 2010.

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     40-8-17. Waiver request. -- (a) Formation. - The department of human services, in

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conjunction with the executive office of health and human services, is directed and authorized to

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apply for and obtain any necessary waiver(s), waiver amendment(s) and/or state plan

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amendments from the secretary of the United States department of health and human services,

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including, but not limited to, a an extension of the section 1115(a) global demonstration waiver

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that provides program flexibility in exchange for federal budgetary certainty and under which

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Rhode Island will operate all facets of the state's Medicaid program, except as may be explicitly

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exempted under any applicable public or general laws. amended, as appropriate, and renamed to

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reflect the state's effort to coordinate all publicly financed healthcare. The secretary of the office

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shall ensure that the state's health and human services departments and the people and

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communities they serve in the Medicaid program shall have the opportunity to contribute to and

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collaborate in the formulation of any request for a new waiver, waiver extension and/or state plan

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amendment(s). Any such actions shall: (1) continue efforts to re-balance the system of long-term

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services and supports by assisting people in obtaining care in the most appropriate and least

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restrictive setting; (2) pursue further utilization of care management models that promote

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preventive care, offer a health home, and provide an integrated system of services; (3) use smart

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payments and purchasing to finance and support Medicaid initiatives that fill gaps in the

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integrated system of care; and (4) recognize and assure access to non-medical services and

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supports, such as peer navigation and employment and housing stabilization services, that are

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essential for optimizing a person's health, wellness and safety and that reduce or delay the need

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for long-term services and supports.

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      (b) Effective July 1, 2009, any provision presently in effect in the Rhode Island General

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Laws where the department of human services, in conjunction with the executive office of health

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and human services, is authorized to apply for and obtain any necessary waiver(s), waiver

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amendment(s) and/or state plan amendment(s) for the purpose of providing medical assistance to

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recipients, shall authorize the department of human services, in conjunction with the executive

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office of health and human services, to proceed with appropriate category changes in accordance

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with the special terms and conditions of the Rhode Island Global Consumer Choice Compact

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section 1115(a) Demonstration Waiver, which became effective January 16, 2009. or any

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extension thereof, as amended and/or renamed under the authority provided in this section.

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     40-8-19. Rates of payment to nursing facilities. -- (a) Rate reform. (1) The rates to be

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paid by the state to nursing facilities licensed pursuant to chapter 17 of title 23, and certified to

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participate in the Title XIX Medicaid program for services rendered to Medicaid-eligible

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residents, shall be reasonable and adequate to meet the costs which must be incurred by

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efficiently and economically operated facilities in accordance with 42 U.S.C. § 1396a(a)(13). The

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executive office of health and human services shall promulgate or modify the principles of

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reimbursement for nursing facilities in effect as of July 1, 2011 to be consistent with the

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provisions of this section and Title XIX, 42 U.S.C. § 1396 et seq., of the Social Security Act.

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     (2) The executive office of health and human services (“Executive Office”) shall review

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the current methodology for providing Medicaid payments to nursing facilities, including other

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long-term care services providers, and is authorized to modify the principles of reimbursement to

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replace the current cost based methodology rates with rates based on a price based methodology

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to be paid to all facilities with recognition of the acuity of patients and the relative Medicaid

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occupancy, and to include the following elements to be developed by the executive office:

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     (i) A direct care rate adjusted for resident acuity;

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     (ii) An indirect care rate comprised of a base per diem for all facilities;

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     (iii) A rearray of costs for all facilities every three (3) years beginning October, 2015,

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which may or may not result in automatic per diem revisions;

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     (iv) Application of a fair rental value system;

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     (v) Application of a pass-through system; and

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     (vi) Adjustment of rates by the change in a recognized national nursing home inflation

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index to be applied on October 1st of each year, beginning October 1, 2012. This adjustment will

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not occur on October 1, 2013, but will resume on October 1, 2014. Said inflation index shall be

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applied without regard for the transition factor in subsection (b)(2) below.

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     (b) Transition to full implementation of rate reform. For no less than four (4) years after

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the initial application of the price-based methodology described in subdivision (a)(2) to payment

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rates, the department executive office of health and human services shall implement a transition

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plan to moderate the impact of the rate reform on individual nursing facilities. Said transition

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shall include the following components:

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     (1) No nursing facility shall receive reimbursement for direct care costs that is less than

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the rate of reimbursement for direct care costs received under the methodology in effect at the

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time of passage of this act; and

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     (2) No facility shall lose or gain more than five dollars ($5.00) in its total per diem rate

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the first year of the transition. The adjustment to the per diem loss or gain may be phased out by

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twenty-five percent (25%) each year; and

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     (3) The transition plan and/or period may be modified upon full implementation of

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facility per diem rate increases for quality of care related measures. Said modifications shall be

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submitted in a report to the general assembly at least six (6) months prior to implementation.

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     SECTION 2. Title 40 of the General Laws entitled "HUMAN SERVICES" is hereby

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amended by adding thereto the following chapter:

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     CHAPTER 40-8.12

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     HEALTH CARE FOR ADULTS

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     40-8.12-1. Purpose. -- Pursuant to section 42-12.3-2, it is the intent of the general

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assembly to create access to comprehensive health care for uninsured Rhode Islanders. The

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Rhode Island Medicaid program has become an important source of insurance coverage for low

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income pregnant women, families with children, elders, and persons with disabilities who might

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not be able otherwise to obtain or afford health care. Under the U.S. Patient Protection and

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Affordable Care Act (ACA) of 2010, all Americans will be required to have health insurance, with

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some exceptions, beginning in 2014. Federal funding is available with ACA implementation to

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help pay for health insurance for low income adults, ages nineteen (19) to sixty-four (64), who do

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not qualify for Medicaid eligibility under Rhode Island general and public laws. It is the intent of

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the general assembly, therefore, to implement the Medicaid expansion for adults without

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dependent children authorized by the ACA, to extend health insurance coverage to these Rhode

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Islanders and further the goal established in section 42-12.3-2 in1993.

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     40-8.12-2. Eligibility.-- (a) Medicaid coverage for non-pregnant adults without children.

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There is hereby established, effective January 1, 2014, a category of Medicaid eligibility pursuant

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to Title XIX of the Social Security Act, as amended by the U.S. Patient Protection and

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Affordable Care Act (ACA) of 2010, 42 U.S.C. section 1396u-1, for adults ages nineteen (19) to

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sixty-four (64) who do not have dependent children and do not qualify for Medicaid under Rhode

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Island general laws applying to families with children and adults who are blind, aged or living

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with a disability. The executive office of health and human services is directed to make any

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amendments to the Medicaid state plan and waiver authorities established under title XIX

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necessary to implement this expansion in eligibility and assure the maximum federal contribution

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for health insurance coverage provided pursuant to this chapter.  

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     (b) Income. The secretary of the executive office of health and human services is

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authorized and directed to amend the Medicaid Title XIX state plan and, as deemed necessary,

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any waiver authority to effectuate this expansion of coverage to any Rhode Islander who qualifies

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for Medicaid eligibility under this chapter with income at or below one hundred and thirty-three

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percent (133%) the federal poverty level, based on modified adjusted gross income.  

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     (c) Delivery system. The executive office of health and human services is authorized and

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directed to apply for and obtain any waiver authorities necessary to provide persons eligible under

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this chapter with managed, coordinated health care coverage consistent with the principles set

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forth in section 42-12.4, pertaining to a health care home.

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     40-8.12-3. Premium assistance program. – (a) The office of health and human services

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is directed to amend its rules and regulations to implement a premium assistance program for

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adults with dependent children, enrolled in the state's health benefits exchange, whose annual

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income and resources meet the guidelines established in section 40-8.4-4 in effect on December

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1, 2013. The premium assistance will pay one-half of the cost of a commercial plan that a parent

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may incur after subtracting the cost-sharing requirement under section 40-8.4-4 as of December

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31, 2013 and any applicable federal tax credits available. The office is also directed to amend the

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1115 waiver demonstration extension and the medical assistance title XIX state plan for this

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program if it is determined that it is eligible for funding pursuant to title XIX of the social

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security act.

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     (b) The office of health and human services shall require any individual receiving

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benefits under a state funded healthcare assistance program to apply for any health insurance for

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which he or she is eligible, including health insurance available through the health benefits

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exchange. Nothing shall preclude the state from using funds appropriated for affordable care act

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transition expenses to reduce the impact on an individual who has been transitioned from a state

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program to a health insurance plan available through the health benefits exchange. It shall not be

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deemed cost effective for the state if it would result in a loss of benefits or an increase in the cost

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of health care services for the person above an amount deemed de minimus as determined by state

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regulation.

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     SECTION 3. Section 42-12.4-8 of the General Laws in Chapter 42-12.4 entitled "The

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Rhode Island Medicaid Reform Act of 2008" is hereby amended to read as follows:

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     42-12.4-8. Demonstration termination. -- Demonstration expiration or termination.-

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In the event the demonstration is suspended or terminated for any reason, or in the event that the

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demonstration expires, the department of human services, in conjunction with the executive office

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of health and human services, is directed and authorized to apply for and obtain all waivers an

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extension or renewal of the section 1115 research and demonstration waiver or any new waiver(s)

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that, at a minimum, ensure continuation of the waiver authorities in existence prior to the

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acceptance of the demonstration. The office shall ensure that any such actions are conducted in

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accordance with applicable federal guidelines pertaining to section 1115 demonstration waiver

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renewals, extensions, suspensions or terminations. The department of human services and the

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executive office of health and human services to the extent possible shall ensure that said waivers

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waiver authorities are reinstated prior to any suspension, termination, or expiration of the

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demonstration.

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     SECTION 4. Section 40-8.4-4 of the General Laws in Chapter 40-8.4 entitled "Health

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Care For Families" is hereby amended to read as follows:

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     40-8.4-4. Eligibility. -- (a) Medical assistance for families. - There is hereby established

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a category of medical assistance eligibility pursuant to section 1931 of Title XIX of the Social

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Security Act, 42 U.S.C. section 1396u-1, for families whose income and resources are no greater

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than the standards in effect in the aid to families with dependent children program on July 16,

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1996 or such increased standards as the department may determine. The department office of

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health and human services is directed to amend the medical assistance Title XIX state plan and to

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submit to the U.S. Department of Health and Human Services an amendment to the RIte Care

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waiver project to provide for medical assistance coverage to families under this chapter in the

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same amount, scope and duration as coverage provided to comparable groups under the waiver.

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The department is further authorized and directed to submit such amendments and/or requests for

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waivers to the Title XXI state plan as may be necessary to maximize federal contribution for

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provision of medical assistance coverage provided pursuant to this chapter, including providing

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medical coverage as a "qualified state" in accordance with Title XXI of the Social Security Act,

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42 U.S.C. section 1397 et seq. Implementation of expanded coverage under this chapter shall not

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be delayed pending federal review of any Title XXI amendment or waiver.

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      (b) Income. - The director secretary of the department office of health and human

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services is authorized and directed to amend the medical assistance Title XIX state plan or RIte

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Care waiver to provide medical assistance coverage through expanded income disregards or other

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methodology for parents or relative caretakers whose income levels are below one hundred

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seventy-five percent (175%) one hundred thirty-three percent (133%) of the federal poverty level.

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      (c) Waiver. - The department of human services is authorized and directed to apply for

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and obtain appropriate waivers from the Secretary of the U.S. Department of Health and Human

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Services, including, but not limited to, a waiver of the appropriate provisions of Title XIX, to

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require that individuals with incomes equal to or greater than one hundred fifty percent (150%) of

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the federal poverty level pay a share of the costs of their medical assistance coverage provided

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through enrollment in either the RIte Care Program or under the premium assistance program

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under section 40-8.4-12, in a manner and at an amount consistent with comparable cost-sharing

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provisions under section 40-8.4-12, provided that such cost sharing shall not exceed five percent

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(5%) of annual income for those with annual income in excess of one hundred fifty percent

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(150%); and provided, further, that cost-sharing shall not be required for pregnant women or

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children under age one.

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     SECTION 5. Section 40-8.4-12 of the General Laws in Chapter 40-8.4 entitled "Health

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Care For Families" is hereby amended to read as follows:

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     40-8.4-12. RIte Share Health Insurance Premium Assistance Program. -- (a) Basic

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RIte Share Health Insurance Premium Assistance Program. - The department office of health and

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human services is authorized and directed to amend the medical assistance Title XIX state plan to

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implement the provisions of section 1906 of Title XIX of the Social Security Act, 42 U.S.C.

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section 1396e, and establish the Rhode Island health insurance premium assistance program for

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RIte Care eligible parents families with incomes up to one hundred seventy-five percent (175%)

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two hundred fifty percent (250%) of the federal poverty level who have access to employer-based

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health insurance. The state plan amendment shall require eligible individuals families with access

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to employer-based health insurance to enroll themselves and/or their family in the employer-

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based health insurance plan as a condition of participation in the RIte Share program under this

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chapter and as a condition of retaining eligibility for medical assistance under chapters 5.1 and

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8.4 of this title and/or chapter 12.3 of title 42 and/or premium assistance under this chapter,

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provided that doing so meets the criteria established in section 1906 of Title XIX for obtaining

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federal matching funds and the department has determined that the individual's and/or the family's

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enrollment in the employer-based health insurance plan is cost-effective and the department has

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determined that the employer-based health insurance plan meets the criteria set forth in

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subsection (d). The department shall provide premium assistance by paying all or a portion of the

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employee's cost for covering the eligible individual or his or her family under the employer-based

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health insurance plan, subject to the cost sharing provisions in subsection (b), and provided that

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the premium assistance is cost-effective in accordance with Title XIX, 42 U.S.C. section 1396 et

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seq.

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      (b) Individuals who can afford it shall share in the cost. - The department office of health

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and human services is authorized and directed to apply for and obtain any necessary waivers from

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the secretary of the United States Department of Health and Human Services, including, but not

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limited to, a waiver of the appropriate sections of Title XIX, 42 U.S.C. section 1396 et seq., to

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require that individuals families eligible for RIte Care under this chapter or chapter 12.3 of title

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42 with incomes equal to or greater than one hundred fifty percent (150%) of the federal poverty

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level pay a share of the costs of health insurance based on the individual's ability to pay, provided

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that the cost sharing shall not exceed five percent (5%) of the individual's annual income. The

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department of human services shall implement the cost-sharing by regulation, and shall consider

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co-payments, premium shares or other reasonable means to do so.

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      (c) Current RIte Care enrollees with access to employer-based health insurance. - The

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department office of health and human services shall require any individual family who receives

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RIte Care or whose family receives RIte Care on the effective date of the applicable regulations

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adopted in accordance with subsection (f) to enroll in an employer-based health insurance plan at

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the individual's eligibility redetermination date or at an earlier date determined by the department,

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provided that doing so meets the criteria established in the applicable sections of Title XIX, 42

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U.S.C. section 1396 et seq., for obtaining federal matching funds and the department has

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determined that the individual's and/or the family's enrollment in the employer-based health

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insurance plan is cost-effective and has determined that the health insurance plan meets the

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criteria in subsection (d). The insurer shall accept the enrollment of the individual and/or the

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family in the employer-based health insurance plan without regard to any enrollment season

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restrictions.

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      (d) Approval of health insurance plans for premium assistance. - The department office

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of health and human services shall adopt regulations providing for the approval of employer-

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based health insurance plans for premium assistance and shall approve employer-based health

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insurance plans based on these regulations. In order for an employer-based health insurance plan

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to gain approval, the department must determine that the benefits offered by the employer-based

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health insurance plan are substantially similar in amount, scope, and duration to the benefits

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provided to RIte Care eligible persons by the RIte Care program, when the plan is evaluated in

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conjunction with available supplemental benefits provided by the department office. The

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department office shall obtain and make available to persons otherwise eligible for RIte Care as

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supplemental benefits those benefits not reasonably available under employer-based health

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insurance plans which are required for RIte Care eligible persons by state law or federal law or

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regulation.

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      (e) Maximization of federal contribution. - The department office of health and human

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services is authorized and directed to apply for and obtain federal approvals and waivers

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necessary to maximize the federal contribution for provision of medical assistance coverage

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under this section, including the authorization to amend the Title XXI state plan and to obtain any

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waivers necessary to reduce barriers to provide premium assistance to recipients as provided for

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in Title XXI of the Social Security Act, 42 U.S.C. section 1397 et seq.

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      (f) Implementation by regulation. - The department office of health and human services

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is authorized and directed to adopt regulations to ensure the establishment and implementation of

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the premium assistance program in accordance with the intent and purpose of this section, the

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requirements of Title XIX, Title XXI and any approved federal waivers.

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     SECTION 86. Rhode Island Medicaid Reform Act of 2008.

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     WHEREAS, The General Assembly enacted Chapter 12.4 of Title 42 entitled “The

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Rhode Island Medicaid Reform Act of 2008”; and

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     WHEREAS, A Joint Resolution is required pursuant to Rhode Island General Laws § 42-

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12.4-1, et seq.; and

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     WHEREAS, Rhode Island General Law § 42-12.4-7 provides that any change that

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requires the implementation of a rule or regulation or modification of a rule or regulation in

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existence prior to the implementation of the global consumer choice section 1115 demonstration

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(“the demonstration”) shall require prior approval of the general assembly; and further provides

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that any category II change or category III change as defined in the demonstration shall also

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require prior approval by the general assembly; and

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     WHEREAS, Rhode Island General Law § 42-7.2-5 provides that the Secretary of the

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Office of Health and Human Services is responsible for the “review and coordination of any

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Global Consumer Choice Compact Waiver requests and renewals as well as any initiatives and

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proposals requiring amendments to the Medicaid state plan or category II or III changes” as

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described in the demonstration, with “the potential to affect the scope, amount, or duration of

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publicly-funded health care services, provider payments or reimbursements, or access to or the

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availability of benefits and services as provided by Rhode Island general and public laws”; and

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     WHEREAS, In pursuit of a more cost-effective consumer choice system of care that is

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fiscally sound and sustainable, the secretary requests general assembly approval of the following

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proposals to amend the demonstration:

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     (a) Nursing Facility Payment Rates - Eliminate Rate Increase. The Medicaid agency

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proposes to eliminate the projected nursing facility rate increase and associated hospice rate

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increase that would otherwise become effective during state fiscal year 2014. A Category II

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change is required to implement this proposal under the terms and conditions of the Global

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Consumer Choice Compact Waiver. Further, this change may also require the adoption of new or

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amended rules, regulations and procedures.

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     (b) Medicaid Hospital Payment Rates - Eliminate Adjustments. The Medicaid single state

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agency proposes to reduce hospital payments by eliminating the projected inpatient and outpatient

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hospital rate increase for state fiscal year 2014. A Category II change is required to implement

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this proposal under the terms and conditions of the Global Consumer Choice Compact Waiver.

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Further, this change may also require the adoption of new or amended rules, regulations and

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procedures.

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     (c) Integrated Care initiative - Implementation Phase-in. The Medicaid single state

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agency proposes to continue implementation of the Medicaid Integrated Care Initiative for Adults

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authorized under the Rhode Island Medicaid Reform Act of 2008, as amended in 2011. Moving

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the initiative forward may require Category II changes under the terms and conditions of the

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Global Consumer Choice Compact Waiver and the adoption of new or amended rules, regulations

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and procedures.

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     (d) BHDDH System Reforms - implementation of Employment First Initiative. As part of

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ongoing reforms promoting rehabilitation services that enhance a person’s dignity, self-worth and

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connection to the community, the Department of Behavioral Healthcare, Developmental

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Disabilities, and Hospitals proposes to change Medicaid financing to support the Employment

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First initiative. The initiative uses reductions in Medicaid payments to provide incentives for

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service alternatives that optimize health and independence. The resulting changes in payment

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rates may require Category II changes under the terms and conditions of the Global Consumer

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Choice Compact Waiver and the adoption of new or amended rules, regulations and procedures.

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     (e) Costs Not Otherwise Matchable (CNOM) Federal Funding. Implementation of the

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U.S. Patient Protection and Affordable Care Act of 2010 will render it unnecessary for the

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Medicaid agency to continue to pursue federal CNOM funding for services to certain newly

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Medicaid eligible populations served by the Executive Office of Health and Human Services, the

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Department of Human Services and the Department of Behavioral Healthcare, Developmental

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Disabilities and Hospitals. Category II changes may be necessary under the terms and conditions

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of the Global Consumer Choice Compact Waiver to facilitate the transition of the affected people

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and services to full Medicaid coverage.

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     (f) Approved Authorities: Section 1115 Waiver Demonstration Extension. The Medicaid

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agency proposes to implement authorities approved under the Section 1115 waiver demonstration

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extension request - formerly known as the Global Consumer Choice Waiver - that (1) continue

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efforts to re-balance the system of long term services and supports by assisting people in

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obtaining care in the most appropriate and least restrictive setting; (2) pursue further utilization of

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care management models that offer a health home, promote access to preventive care, and provide

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an integrated system of services; (3) use smart payments and purchasing to finance and support

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Medicaid initiatives that fill gaps in the integrated system of care; and (4) recognize and assure

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access to non-medical services and supports, such as peer navigation and employment and

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housing stabilization services, that are essential for optimizing a person’s health, wellness and

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safety and that reduce or delay the need for long term services and supports.

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     (g) Medicaid Requirements and Opportunities under the US. Patient Protection and

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Affordable Care Act of 2010. The Medicaid agency proposes to pursue any requirements and/or

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opportunities established under the U.S. Patient Protection and Affordable Care Act of 2010 that

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may warrant a Medicaid State Plan Amendment and/or a Category II or III change under the

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terms and conditions of the Global Consumer Choice Compact Waiver or its successor or any

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extension thereof. Such opportunities and requirements include, but are not limited to: (1) the

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continuation of coverage for youths who had been in substitute care who are at least eighteen (18)

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years old but are not yet twenty-six (26) years of age, and who are eligible for Medicaid coverage

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under the Foster Care Independence Act of 1999 (2) the maximizing of Medicaid federal

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matching funds for any services currently administered by the health and human services

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agencies that are authorized under Rhode Island general and public laws. Any such actions the

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Medicaid agency takes shall not have an adverse impact on beneficiaries or cause there to be an

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increase in expenditures beyond the amount appropriated for state fiscal year 2014. Now,

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therefore, be it

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     (h) RIte Care Parents Eligibility. The Medicaid single state agency proposes to reduce

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the RIte Care coverage income eligibility threshold for parents to one hundred thirty-three percent

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(133%) of the federal poverty level. A Category III change is required to implement this proposal

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under the terms and conditions of the Global Consumer Choice Compact Waiver. Further this

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change requires the adoption of amended rules, regulations and procedures.

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     (i) Cortical Integrative Therapy. The Medicaid single state agency shall seek to create a

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new service entitled Cortical Integrative Therapy. This service is designed to effectuate either

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neuronal excitation or inhibition through temporal and spatial summation to strengthen synaptic

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connections. Creating this new service may require Category II changes under the terms and

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conditions of the Global Consumer Choice Waiver and the adoption of new or amended rules,

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regulations, and procedures;

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     Now, therefore, be it

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     RESOLVED, that the general assembly hereby approves proposals (a) through (f)(i)

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listed above to amend the demonstration; and be it further

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     RESOLVED, that the secretary of the office of health and human services is authorized

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to pursue and implement any waiver amendments, category II or category III changes, state plan

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amendments and/or changes to the applicable department’s rules, regulations and procedures

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approved herein and as authorized by § 42-12.4-7.

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     SECTION 9. This article shall take effect upon passage. SECTION 7. Section 4 of this article

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shall take effect on January 1, 2014. The remainder of this Article shall take effect upon passage.